Treatment algorithm for the injured spine.

The distinction that matters most: we are the medical decision-maker, not the proceduralist. When a patient needs an epidural, a medial branch block, an ablation, or a surgical opinion, we refer — and the referral names what we think is wrong and what we are asking for. When a patient needs opioid therapy beyond a short rescue course, we refer to pain management for a controlled-substance agreement. We do not hold that agreement.

Because care is delivered by telehealth, this algorithm is explicit at every step about which findings must come from a documented in-person examination rather than from the video visit. See §11.

Required intake data

Red flags — screened at every visit

This panel is identical in every module. It is a safety artifact, not copy.

Source: ACR Appropriateness Criteria® Low Back Pain, 2021 update (ref. 3); NICE cauda equina red-flag criteria.

Imaging at intake

Patients referred into this practice usually arrive with imaging already obtained — from the emergency department, the referring chiropractor, or an urgent care. Reviewing what exists, and deciding whether more is needed, happens at the initial consultation. It is not deferred to a later visit.

Order additional imaging at the initial consultation when

• Any red flag is present — and note that trauma is itself a red flag under the ACR criteria, so a significant collision mechanism supports imaging on its own
• There is a neurologic deficit, or symptoms suggesting one
• Fracture or instability is suspected — including a fragility fracture, where an MRI STIR sequence is needed to establish acuity
• Existing imaging is inadequate for the clinical question, per the table above
• Symptoms have materially changed since the existing study

Do not order additional imaging at intake when

• The presentation is uncomplicated axial pain from a low-energy mechanism, with no red flag and no deficit, and existing imaging is adequate
• The only reason to image is that a claim exists

Stage 0 output

Every patient leaves Stage 0 with a working diagnosis phrased as a specific anatomic hypothesis (not "back pain"), a red-flag disposition, a stage assignment, a module assignment, and a written reassessment date.

Clinically meaningful improvement is defined as ≥30% improvement in both pain and function — the definition used in the CDC 2022 guideline. Function is tracked with a named instrument (Oswestry Disability Index for low back, Neck Disability Index for cervical) recorded at every visit. In a personal-injury case, a serially recorded validated score is worth more than any amount of narrative.

A typical uncomplicated case is 4–6 visits over 12 weeks. A case that escalates to intervention or surgery runs 7–10 visits over 6–9 months. A case that resolves at Stage 1 is 2–3 visits and should be discharged, not carried.

Stage 1 — weeks 0 to 6

Non-pharmacologic — first-line Strong

"Given that most patients with acute or subacute low back pain improve over time regardless of treatment, clinicians and patients should select nonpharmacologic treatment with superficial heat (moderate-quality evidence), massage, acupuncture, or spinal manipulation (low-quality evidence). If pharmacologic treatment is desired, clinicians and patients should select nonsteroidal anti-inflammatory drugs or skeletal muscle relaxants (moderate-quality evidence)."

ACP 2017, Recommendation 1 — Grade: strong recommendation. Ref. 1

• Superficial heat — moderate-quality evidence, the best-supported item on the list
• Spinal manipulation — what the referring chiropractor is already providing, and guideline-concordant care for this presentation. Co-management is documented as deliberate, not incidental.
• Stay active; avoid bed rest. Reassurance about the favourable natural history is itself an intervention.

Pharmacologic — first-line

• NSAID, scheduled (not PRN) for 7–14 days, then PRN. Agent, dose, and the GI/CV/renal screen in §9.
• ± Skeletal muscle relaxant at night for the first 7–14 days if there is demonstrable spasm or sleep disruption.

Do not use

• Against Acetaminophen as monotherapy for acute low back pain. The PACE trial (Lancet 2014; n=1,652) found median time to recovery of 17 days on scheduled paracetamol, 17 days as-needed, and 16 days on placebo. It may still be used as an adjunct where NSAIDs are contraindicated, but should not be represented as effective for this indication.
• Never Benzodiazepines as muscle relaxants.
• Never Carisoprodol (Soma) — see §9.2.

Stage 2 — reassessment at 4 to 6 weeks

The imaging question was settled at intake (§01). This visit is a response check, not an imaging decision.

• Improving (≥30% pain and function): continue Stage 1, taper medications, plan discharge.
• Not improving: move to Stage 3. Image now only if the question was left open at intake — adequate existing imaging, no red flag, no deficit — and failure to improve has now made the anatomy relevant. MRI without contrast of the symptomatic region. Plain films add little absent trauma or suspected instability; flexion–extension views only if instability is specifically suspected.
• Any new red flag or deficit: back to Stage 0, image immediately, irrespective of the interval.

Imaging is usually not appropriate for acute low back pain, with or without radiculopathy, when there are no red flags and no prior management. Imaging is considered in patients who have had up to six weeks of medical management and physical therapy with little or no improvement, and in those with red flags — a list on which trauma appears. MRI is the preferred modality when imaging is indicated.

ACR Appropriateness Criteria® Low Back Pain, 2021 update. Ref. 3

For the injury case: the rationale belongs in the note either way. "Existing lumbar MRI dated ___ reviewed; adequate for the clinical question; no further imaging indicated" is as defensible as ordering a study, and often more so. What is not defensible is an unexplained study with no stated indication.

Stage 3 — weeks 6 to 12

• Continue or optimise the NSAID. No NSAID is superior to another for pain (ACP, moderate-quality evidence) — switch for tolerability, not efficacy.
• Add duloxetine if pain is becoming chronic (>3 months) or has centralising features. ACP Recommendation 3 names duloxetine as second-line pharmacotherapy for chronic low back pain.
• Escalate active rehabilitation: motor control exercise, graded activity, supervised therapy.
• Address sleep and mood directly. Both drive chronification and both are documentable.

Stage 4 — interventional referral

Axial pain refers only when there is a specific, testable pain generator.

"Axial back pain, refer to pain management" is not an adequate referral. See §09.

Stage 5

Axial pain alone is rarely a surgical problem. Refer for surgical opinion only for a structural indication — instability, deformity, fracture, or a documented spondylolisthesis with correlating symptoms.

Stage 1 — weeks 0 to 6

Counsel the natural history explicitly, and document that you did. 60–80% of disc herniations resolve within 6–12 weeks. In SPORT, 34% of enrolled patients never underwent surgery and 75% of those who initially chose non-operative care avoided it. This conversation is both good medicine and, in a case file, evidence that the patient was not steered toward a procedure.

• NSAID, scheduled, as in Module A
• Relative rest for days, not weeks; then progressive activity
• Neural mobilisation / directional preference exercise via the treating provider
• Muscle relaxant only for demonstrable spasm, short course

Gabapentinoids are not first-line for radicular pain Against

Mathieson et al. randomised patients with sciatica to pregabalin (150 mg/day titrated to 600 mg/day) or placebo for up to 8 weeks. The trial missed its primary endpoint — the between-group difference in leg-pain reduction was 0.5 against a prespecified difference of 1.5 — and there were no significant between-group differences on any secondary outcome at either week 8 or week 52, with more adverse events, notably dizziness, in the pregabalin arm.

Mathieson et al., N Engl J Med 2017;376:1111–1120. Ref. 7

Position: gabapentin or pregabalin may be trialled as a documented exception — a patient with prominent neuropathic descriptors who has failed first-line therapy — with a defined trial period and a stop date. Not a routine co-prescription; the note says why it was chosen.

Oral corticosteroids Limited

The evidence for a short oral steroid course in acute radiculopathy is weak — a modest improvement in function without a demonstrated pain benefit. If used: a short defined course, once, with the rationale documented. Not a repeating intervention.

Stage 2 — reassessment at 4 to 6 weeks

Most radicular patients will already have been imaged — at intake or before referral — because a deficit or a significant mechanism is itself an indication (§01). This visit checks response and re-checks the neurologic exam.

• Improving → continue.
• Not improving and not yet adequately imaged → MRI without contrast of the symptomatic region.
• Any new or progressive deficit → image immediately and re-stage, whatever the interval and whatever was found before.
• Correlate rigorously. The imaging finding must match the clinical syndrome. Asymptomatic disc herniations and degenerative findings are extremely common. An MRI report describing a herniation at a level that does not match the dermatome is not the diagnosis. In an injury case, an overstated imaging-to-symptom correlation is exactly what defense counsel will attack — and it is avoidable by writing the correlation carefully the first time.

Stage 4 — interventional referral

Epidural steroid injection for radicular pain from disc herniation Moderate

• Evidence position: ESI produces meaningful short-term (2 weeks–3 months) improvement in leg pain and function. The NASS lumbar disc herniation guideline found insufficient evidence for or against 12-month efficacy, and insufficient evidence that any one approach (transforaminal, interlaminar, caudal) is superior.
• Frame it correctly: an ESI is a bridge that buys a rehabilitation window — not a cure, and not a series. Indicated when radicular pain persists past ~6 weeks of appropriate conservative care and is limiting function or sleep.
• It is not a substitute for a surgical opinion in a patient with a progressing deficit.

Sub-pathway — lumbar spinal stenosis / neurogenic claudication

Distinguish from radicular pain: bilateral or buttock/thigh symptoms, worse with standing and extension, relieved by flexion and sitting, walking tolerance limited by symptoms rather than by pain at rest.

• Stages 1–3: flexion-biased exercise, conditioning, activity pacing, NSAID. This population is typically older — screen renal function and GI risk carefully first.
• Stage 4: ESI is recommended against. Do not send this patient for a series of injections.
• Stage 5: surgical decompression for functionally limiting claudication after failed conservative care. Refer on function — walking tolerance, falls, independence — not on imaging severity alone.

Stage 5 — surgical referral

What to tell the patient about elective discectomy, accurately. SPORT 8-year results — carefully selected surgical patients improved faster and to a greater degree than non-operative patients, and that difference was maintained through 8 years with little degradation from year 4 to year 8. By 8 years, 15% had undergone reoperation, 85% of those for recurrent herniation. Both halves belong in the conversation.

Grades I–II — the evidence supports what the chiropractor is doing

The OPTIMa Collaboration (Ontario Protocol for Traffic Injury Management, an update of the Bone and Joint Decade Task Force on Neck Pain), for recent (0–3 month) neck pain and associated disorders grades I–II, suggests manipulation, mobilisation, range-of-motion home exercise, or multimodal care for reduction in pain.

OPTIMa Collaboration. Ref. 19

Worth stating plainly in the practice's public materials: chiropractic co-management of WAD I–II is guideline-concordant care, not an accommodation to the referral source. The physician's role is diagnosis, grading, red-flag surveillance, medication, and escalation — not duplication of the manual therapy.

• Encourage early return to usual activity; avoid collars and avoid rest
• NSAID short course; muscle relaxant at night if spasm limits sleep
• Reassess at 4–6 weeks. Persistent WAD II beyond 12 weeks → consider cervical facet-mediated pain and route to Stage 4 with a facet hypothesis

Imaging in whiplash

Apply the Canadian C-Spine Rule to the acute post-collision decision. Most of these patients will have been screened at the scene or in an emergency department before reaching this practice — obtain and review that record rather than reflexively re-imaging. Grade III symptoms, or failure to improve by 6 weeks, warrant MRI.

Traumatic thoracolumbar fracture

Classify with TLICS — injury morphology, neurologic status, and integrity of the posterior ligamentous complex.

This practice does not make the operative decision — it makes the referral, and it uses TLICS as the vocabulary. Recent literature argues the neurologically intact TLICS 4–5 burst fracture deserves a trial of non-operative management (ref. 17); the evidence base is limited and largely expert opinion, so the surgeon decides.

• Any suspected traumatic fracture with neurologic findings → emergent transfer.
• Neurologically intact, low TLICS: bracing per the treating surgeon, activity modification, analgesia, serial imaging on the surgeon's schedule.
• Do not initiate or adjust a fracture management plan by telehealth without a spine surgeon's involvement.

Osteoporotic / fragility vertebral compression fracture

Common in older collision patients and in low-energy mechanisms — and frequently the causation battleground in the case, because the fracture may be new, old, or an acute-on-chronic event.

Establish acuity. An MRI STIR sequence showing marrow oedema distinguishes an acute fracture from an old one. This single finding often decides both the treatment and the causation question, and it should be obtained rather than assumed.

Vertebral augmentation — narrow indication Moderate

The evidence is genuinely split, and the split is explained by patient selection. The VAPOUR trial found vertebroplasty superior to placebo specifically in acute (<6 weeks), severe, refractory fractures, with benefit persisting to about 6 months. Earlier trials (INVEST, Buchbinder) that enrolled more chronic and less severe fractures were negative.

Clark et al., Lancet 2016;388:1408–1416. Ref. 15

Refer for augmentation consideration only when all of: the fracture is acute (<6 weeks, confirmed by marrow oedema), pain is severe, and pain is refractory to adequate analgesia. Not for the incidental old wedge fracture on a CT.

• Limit all acute analgesic use to fewer than 10–15 days per month, and say so explicitly
• Treat migraine phenotype with migraine-specific agents
• Refer to neurology for headaches not resolving by ~3 months, or any atypical feature

• Strong Topical NSAIDs belong here — this is where the evidence actually is. Cochrane review of topical NSAIDs for acute musculoskeletal pain (Derry 2015): diclofenac and ketoprofen gels give good levels of pain relief, probably similar to oral NSAIDs, with minimal adverse events. For chronic musculoskeletal pain, topical diclofenac and ketoprofen are supported principally in knee osteoarthritis.
• Preferring a topical NSAID over an oral one for a localised extremity injury is a real clinical decision with real evidence behind it — lower systemic GI, renal, and cardiovascular exposure for comparable relief.
• Relative rest, ice in the acute phase, compression, progressive loading
• Imaging per the relevant decision rule (Ottawa ankle/knee rules); MRI for suspected internal derangement not improving by 4–6 weeks
• Refer to orthopaedics for suspected complete tendon rupture, mechanical locking, instability, or failure to progress

9.1  NSAIDs Moderate

The Cochrane review of NSAIDs for acute low back pain found NSAIDs slightly more effective than placebo for short-term pain reduction, disability, and global improvement — but the magnitude of the effects is small and probably not clinically relevant. They remain the reasonable first-line drug on the balance of benefit, safety, and cost. ACP notes no NSAID is superior to another for pain — switch agents for tolerability, not for efficacy.

van der Gaag et al., Cochrane 2020, CD013581. Ref. 6

9.2  Skeletal muscle relaxants

Duration cap: 2–3 weeks. No routine refills.

Counselling, documented: sedation; no driving until the individual response is known; no alcohol.

9.3  Topical and adjunctive agents

9.4  Neuropathic and centralising-pain agents

9.5  Opioids

Citing this rule honestly

Why the practice holds this line

A 12-month randomised trial in 240 patients with moderate-to-severe chronic back pain or hip/knee osteoarthritis pain. Opioid therapy was not superior to non-opioid medication for pain-related function. Pain intensity was significantly worse in the opioid group (4.0 vs 3.5, p=0.03), and adverse medication effects were more common. The authors concluded the results do not support initiation of opioid therapy for these conditions.

SPACE trial — Krebs et al., JAMA 2018;319:872–882. Ref. 8

"Nonopioid therapies are at least as effective as opioids for many common types of acute pain."  —  "Nonopioid therapies are preferred for subacute and chronic pain."

CDC 2022, Recommendations 1 and 2. Ref. 2

Texas regulatory requirement

Texas law requires the prescriber to review the patient's PMP Aware history before each prescription for opioids, benzodiazepines, barbiturates, or carisoprodol issued for take-home use, and to document that review in the medical record. In effect since 1 March 2020; exceptions exist for patients with cancer diagnoses and those in hospice.

Operationally: the PMP query is a discrete line in every note in which a controlled substance is prescribed. Not a template phrase — a dated, specific entry.

11.1  Suspected facet-mediated pain → dual comparative medial branch blocks

ASIPP facet joint guideline — lumbar radiofrequency ablation: Level II evidence, moderate strength of recommendation (11 relevant RCTs). Therapeutic lumbar medial branch blocks: Level II, moderate. Intra-articular facet joint injections: Level IV, weak — the majority of relevant RCTs show a lack of effectiveness. Selection paradigm: dual comparative medial branch blocks with ≥80% concordant relief is the standard accepted by the Spine Intervention Society and by Medicare LCDs.

Refs. 12, 13

The referral letter states:

• The diagnostic hypothesis and the levels suspected
• A request for dual comparative medial branch blocks with an ≥80% concordant-relief threshold before proceeding to radiofrequency ablation
• That intra-articular facet injection is not the requested procedure (Level IV, weak)

11.2  Suspected sacroiliac joint pain → dual diagnostic blocks

SI joint pain cannot be diagnosed definitively by history, examination, or imaging. Diagnostic blocks are required, and dual blocks reduce the false-positive rate. NASS supports radiofrequency denervation after two intra-articular test blocks; sacral lateral branch radiofrequency neurotomy success rates are reported at 43–64%. Set that expectation with the patient in advance.

11.3  Radicular pain from disc herniation → epidural steroid injection

Request it as a bridge to rehabilitation, name the level and side, and state the duration of failed conservative care. Not a standing series.

11.4  Cervical transforaminal injection — mandatory safety language

11.5  What comes back

The referral requests, in return: the procedure note, the fluoroscopic documentation, the percentage and duration of relief, and the proceduralist's recommendation. Percentage and duration of relief are what determine the next step in this algorithm — a referral that returns "patient did well" is not usable.

The referral packet contains: the working diagnosis; the imaging and reports; the documented neurologic examination with dates; the complete list of conservative measures tried with durations; the response to any interventional procedure with percentage and duration of relief; and the current functional score.

A surgeon receiving a complete packet makes a faster and better decision — and in an injury case, a documented conservative-care trail is what establishes that surgery was necessary rather than elective.

How this practice manages that gap

• The referring chiropractor's documented in-person examination is obtained and reviewed at intake and at each reassessment. Findings are attributed in the note to their source and date — never recorded as if personally performed.
• Any decision that turns on a finding this practice cannot obtain remotely — most importantly motor grading — triggers a request for an in-person examination before that decision is made, not after.
• Red-flag symptoms elicited by history route to an emergency department, which performs the examination. The algorithm never attempts to exclude cauda equina syndrome remotely.
• The limitation is stated in the medical record, not just in the terms of service.

Nothing in this document should be read as claiming a physical examination that did not occur. In a case file, a note that carefully distinguishes observed from reported from received-in-records is worth considerably more than one that blurs them.

1. Date, modality (telehealth), patient location, and consent to telehealth
2. Mechanism and date of injury, restated
3. Interval history since last visit
4. Source-attributed examination findings — what was observed on video, what came from whose in-person examination and when
5. Validated functional score (ODI / NDI) with the trend
6. Imaging reviewed, with the correlation to symptoms stated explicitly
7. Working diagnosis — anatomic and specific
8. Stage assignment and the reason for it
9. Treatment plan with named agents, doses, and durations
10. PMP query documented if a controlled substance was prescribed
11. Red-flag screen — explicitly negative or positive
12. Next reassessment date
13. Referral rationale where a referral was made

13.1  The reference schedule

13.2  Schedule of charges — 2026

2026 total non-facility RVUs. Codes 99202 and 99212 are not listed because this practice's visits do not support those levels.

13.3  What each visit includes

A charge should say what was done for it. Every item below is performed and documented at the visit named, and appears in the note that goes to the referring attorney.

13.4  What a case costs

Derived from the visit cadence in §06. These are physician professional fees only — they do not include imaging, chiropractic care, interventional procedures, or surgery, each of which will exceed them.

13.5  How the schedule is applied

• One schedule for every patient, regardless of how the service is paid. There is no separate letter-of-protection rate.
• The code is selected from the completed note, by medical decision-making or total time. The note is never written to support a predetermined level.
• No charge is added for reviewing outside records or imaging. That work is a component of medical decision-making, reflected in the level selected rather than billed separately.
• Charges are not contingent on the outcome of any claim, the size of any settlement, or any referral relationship.
• Reviewed each January, when the Texas DWC conversion factor updates. The multiple stays at 1.75× unless a documented decision changes it; every version is retained with its effective dates.

13.6  Reductions

1. Qaseem A, Wilt TJ, McLean RM, Forciea MA. Noninvasive treatments for acute, subacute, and chronic low back pain: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2017;166(7):514–530. PMID 28192789.
2. Dowell D, Ragan KR, Jones CM, Baldwin GT, Chou R. CDC Clinical Practice Guideline for Prescribing Opioids for Pain — United States, 2022. MMWR Recomm Rep. 2022;71(3):1–95. PMID 36327391.
3. ACR Appropriateness Criteria® Low Back Pain: 2021 Update. J Am Coll Radiol. 2021. PMID 34794594.
4. Friedman BW, Dym AA, Davitt M, et al. Naproxen with cyclobenzaprine, oxycodone/acetaminophen, or placebo for treating acute low back pain: a randomized clinical trial. JAMA. 2015;314(15):1572–1580.
5. Williams CM, Maher CG, Latimer J, et al. Efficacy of paracetamol for acute low-back pain: a double-blind, randomised controlled trial (PACE). Lancet. 2014;384(9954):1586–1596.
6. van der Gaag WH, Roelofs PD, Enthoven WT, van Tulder MW, Koes BW. Non-steroidal anti-inflammatory drugs for acute low back pain. Cochrane Database Syst Rev. 2020;4:CD013581.
7. Mathieson S, Maher CG, McLachlan AJ, et al. Trial of pregabalin for acute and chronic sciatica. N Engl J Med. 2017;376(12):1111–1120. PMID 28614682.
8. Krebs EE, Gravely A, Nugent S, et al. Effect of opioid vs nonopioid medications on pain-related function in patients with chronic back pain or hip or knee osteoarthritis pain: the SPACE randomized clinical trial. JAMA. 2018;319(9):872–882. PMID 29509867.
9. Friedly JL, Comstock BA, Turner JA, et al. A randomized trial of epidural glucocorticoid injections for spinal stenosis (LESS). N Engl J Med. 2014;371(1):11–21.
10. Non-surgical interventions for lumbar spinal stenosis leading to neurogenic claudication: a clinical practice guideline. J Pain. 2021. PMID 33857615.
11. Kreiner DS, Hwang SW, Easa JE, et al. An evidence-based clinical guideline for the diagnosis and treatment of lumbar disc herniation with radiculopathy. Spine J. 2014;14(1):180–191. PMID 24239490.
12. Manchikanti L, Kaye AD, Soin A, et al. Comprehensive evidence-based guidelines for facet joint interventions in the management of chronic spinal pain. Pain Physician. 2020.
13. Schneider BJ, Doan L, Maes MK, et al. Effectiveness of radiofrequency ablation of medial branch nerves for chronic lumbar facet joint syndrome in patients selected by guideline-concordant dual comparative medial branch blocks. Pain Med. 2020;21(5):902–909. PMID 31609391.
14. Weinstein JN, Lurie JD, Tosteson TD, et al. Surgical versus non-operative treatment for lumbar disc herniation: eight-year results for the Spine Patient Outcomes Research Trial (SPORT). Spine. 2014;39(1):3–16.
15. Clark W, Bird P, Gonski P, et al. Safety and efficacy of vertebroplasty for acute painful osteoporotic fractures (VAPOUR): a multicentre, randomised, double-blind, placebo-controlled trial. Lancet. 2016;388(10052):1408–1416.
16. Vaccaro AR, Lehman RA, Hurlbert RJ, et al. A new classification of thoracolumbar injuries (TLICS). Spine. 2005;30(20):2325–2333.
17. The neurologically intact patient with TLICS 4 or 5 burst fracture should be given a trial of nonoperative management. PMID 39560520.
18. Spitzer WO, Skovron ML, Salmi LR, et al. Scientific monograph of the Quebec Task Force on Whiplash-Associated Disorders. Spine. 1995;20(8 Suppl):1S–73S.
19. Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration — systematic reviews on exercise and multimodal care for neck pain and associated disorders.
20. Derry S, Moore RA, Gaskell H, McIntyre M, Wiffen PJ. Topical NSAIDs for acute musculoskeletal pain in adults. Cochrane Database Syst Rev. 2015;6:CD007402.
21. Derry S, Conaghan P, Da Silva JAP, Wiffen PJ, Moore RA. Topical NSAIDs for chronic musculoskeletal pain in adults. Cochrane Database Syst Rev. 2016;4:CD007400. PMID 27103611.
22. Santana JA, Klass S, Felix ER. The efficacy, effectiveness and safety of 5% transdermal lidocaine patch for chronic low back pain: a narrative review. PM R. 2020;12(12):1260–1267. PMID 32189475.
23. Hashmi JA, Baliki MN, Huang L, et al. Lidocaine patch (5%) is no more potent than placebo in treating chronic back pain when tested in a randomised double blind placebo controlled brain imaging study. Mol Pain. 2012;8:29.
24. US Food and Drug Administration Drug Safety Communication: serious neurologic events after epidural corticosteroid injection. 2014.
25. Texas Medical Board / Texas State Board of Pharmacy — Prescription Monitoring Program mandatory-check guidance, effective 1 March 2020.